Toward a better understanding of urinary fistula repair prognosis: Results from a multi-country prospective cohort study
type: CreativeWork
description: This dissertation addresses several critical gaps in the evidence-base with regard to urinary fistula care and treatment in developing countries. First, I systematically reviewed and synthesized the small but growing body of literature examining the patient, fistula and facility-level factors that influence repair outcomes in developing countries. There was insufficient evidence to support a role of patient characteristics in influencing repair outcomes. In contrast, the weight of evidence suggested that some fistula characteristics, particularly scarring and urethral involvement, may influence the risk of failure to close the fistula, residual incontinence following closure and any incontinence. Results from randomized controlled trials examining prophylactic antibiotic use and repair outcomes were inconclusive, and observational studies examining the influence of peri-operative procedures were limited by small sample sizes and lack of statistical adjustment for potential confounding factors. Secondly, using data from a multi-country facility-based prospective cohort study, I examined the prognostic value of five existing classification systems - those developed by Lawson, Tafesse, Goh, the World Health Organization (WHO) and Waaldijk - for predicting fistula closure, and evaluated the prognostic value of a score derived empirically from the data from this study. The scoring systems representing the Tafesse, Goh and WHO and empirically-derived classification systems were similar, and had the highest predictive values. However, none of the scores evaluated achieved good discriminatory ability (AUC > 0.70), suggesting that other factors unrelated to fistula characteristics may be equally or more important in predicting repair outcomes. Finally, I examined several issues surrounding two peri-operative procedures related to fistula surgery: abdominal versus vaginal route of repair, and catheterization duration greater than 14 days (compared to 14 days or less). Specifi…
abstract: This dissertation addresses several critical gaps in the evidence-base with regard to urinary fistula care and treatment in developing countries. First, I systematically reviewed and synthesized the small but growing body of literature examining the patient, fistula and facility-level factors that influence repair outcomes in developing countries. There was insufficient evidence to support a role of patient characteristics in influencing repair outcomes. In contrast, the weight of evidence suggested that some fistula characteristics, particularly scarring and urethral involvement, may influence the risk of failure to close the fistula, residual incontinence following closure and any incontinence. Results from randomized controlled trials examining prophylactic antibiotic use and repair outcomes were inconclusive, and observational studies examining the influence of peri-operative procedures were limited by small sample sizes and lack of statistical adjustment for potential confounding factors. Secondly, using data from a multi-country facility-based prospective cohort study, I examined the prognostic value of five existing classification systems - those developed by Lawson, Tafesse, Goh, the World Health Organization (WHO) and Waaldijk - for predicting fistula closure, and evaluated the prognostic value of a score derived empirically from the data from this study. The scoring systems representing the Tafesse, Goh and WHO and empirically-derived classification systems were similar, and had the highest predictive values. However, none of the scores evaluated achieved good discriminatory ability (AUC > 0.70), suggesting that other factors unrelated to fistula characteristics may be equally or more important in predicting repair outcomes. Finally, I examined several issues surrounding two peri-operative procedures related to fistula surgery: abdominal versus vaginal route of repair, and catheterization duration greater than 14 days (compared to 14 days or less). Specifi…
author: Frajzyngier, Veronica Maya
language: English
keywords: Epidemiology, Fistula, Urinary, Clinical trials, Vagina--Surgery, Urinary organs--Surgery, Public health, Panel analysis, World Health Organization
date published: 2011
date modified: 2026-07-24T01:44:13Z
provider: Columbia University
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Columbia University

PropertyValue
property ID: DOI
value: 10.7916/D8794BNG